An older patient with an infected stage IV pressure ulcer is lethargic. What additional findings should the nurse expect to assess in this stage of septic shock?
Select all that apply.
1. warm, flushed skin
2. urine output 10 mL/hr
3. blood pressure 88/54 mmHg
4. heart rate 118 beats per minute
5. respiratory rate 28 per minute and shallow
Correct Answer: 2, 3, 4, 5
Manifestations of late (cold) septic shock include oliguria to anuria, hypotension, tachycardia, and rapid, shallow respirations. Warm, flushed skin is a manifestation of early (warm) septic shock.
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